[Severe digitalis intoxication. Prognostic factors. Value and limitations of electrosystolic pacemaking (apropos of 133 cases)].
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Biomedical subjects
Publications and source records attributed to F Conso.
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Potassium permanganate tablets are caustic and it has been suggested that they should be removed straightaway by gastrostomy, immediately after swallowing. Some operators have been impressed by the macroscopic appearance of the stomach and have carried out gastrectomy. However, the lesions were only fairly superficial on pathological examination. In the light of a new case and 21 similar cases, treated at the Fernand Widal hospital, the authors discuss other cases in the literature. They conclude: the extreme rareness of digestive perforation; the absence of toxicity of breakdown products of potassium permanganate. They propose treatment of neutralisation of the permanganate with sodium hyposulphite, gastric lavage and supervision on a surgical unit. In case of perforation, they believe that the operation should be conservative.
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The purpose of this study was to estimate the incidence, mortality, and causes of carbon monoxide intoxications in France. A survey was conducted in the department of the Hauts-de-Seine, which is representative of the French population. Data were collected through a headquarters that had direct contact with all department emergency organizations and to a technical laboratory. During the 3-y study, 735 cases that were related to 291 events were reported. Thirty-six patients died. The average incidence of carbon monoxide intoxications was 17.5 per 100,000 inhabitants. Poisoning was caused by fires in 36 events and by car exhausts in 12. For the remaining events, causes were determined as follows for 196: water heaters (57%), boiler (20.5%), coal stove (9%), brazier (4%), cooker (2%), heating device (1.5%), and miscellaneous (6%). The main mechanisms of intoxication were a defective device, poor ventilation, or poor evacuation of combustion gases. Carbon monoxide intoxication occurs frequently in France, and preventive actions are warranted.
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During last 7 years, 13 cases of acute ethylene glycol poisoning have been observed with 4 fatal outbreaks. All cases--except one--were accidental. Six patients had drunk a mixture of antifreeze in water as they were lost in a desert. A patient who had taken 970 ml of ethylene glycol survived. In one case, death was due to irreversible brain damage; two other fatalities occurred from cardiorespiratory distress. CNS involvement was noticed in 8 cases and acute renal failure-constantly controlled-occurred in 9 patients. Post mortem examination has shown bi-refringent calcium oxalate crystals in both kidney and brain. Specific treatment with ethanol has been performed in 3 cases with ingestion of large amounts of toxic who were seen before definitive renal lesions have occurred. Emphasis is placed in symptomatic treatment including gastric lavage, extrarenal epuration and conservative management.
The authors report on a case of lethal lactate acidosis during acute metformine and barbiturate poisoning. The study of energetic substrates and glucoregulation hormones demonstrated a blockade of hepatic gluconeogenesis.
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